dr karl johnson radiologist, birminghamyolink hub

Gordon Jeyes, director of children's services at Cambridgeshire county council until this year, defended his department's decision to press ahead with its application to remove William from his parents' care. In his second report after reviewing the outcome of the medical investigations after his original report he held to the view that there was a high suspicion for a non-accidental causation. Notwithstanding that, I formed the impression that she was seeking to assist the court. His research and clinical interests include the pathogenesis [.] The parents' first child T was born on 14th February 2008. BSc, MBBS, MRCP, FRCR, PhD, FHEA Their care of the children has been observed as of high quality. All the adults appear to be normal hardworking people concerned for their children. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. The outcome of the case, in a landmark High Court judgement, has helped to lift the secrecy surrounding England's family courts, where campaigners claim that a lack of openness creates an environment in which miscarriages of justice can go unnoticed. Interpretation & Reporting Webinar for the General Radiologist, DAY 1: GENERAL PAEDIATRIC RADIOLOGY - WEDNESDAY 9 FEBRUARY 2022 Dr. Foster spent two and a half years working in paediatricsbefore moving into radiology. The question arose as to whether genetic abnormality of bones, metabolic bone disease or demineralisation of the bone caused by Vitamin D deficiency gave rise to an increased propensity to fracture. I have also noted the quotation offered by Miss Trustman from R v Harris and others [2005] EWCA Crim 1980 para. So the records engage even closer scrutiny. After the birth it became apparent he had a medical problem with intestinal obstructions and severe constipation, requiring a good deal of medical attention and a surgical procedure at 3 weeks. The main functions of MRI are as follows: a. early diagnosis of CADM and fasciitis; b. differential diagnosis with other types of myopathies, such as congenital myopathy; c. locating the site for. 14. The burden of proof lies on the local authority and they have to satisfy the court on the balance of probabilities: see Re B (Care proceedings; standard of proof) [2008] UKHL 35. He asserts that he had not witnessed the mother or grandmother behave in this way and did not believe they would have done so when he was not present. He has co-authored over 35 peer reviewed papers. His father described him as "very possessive" of his baby sister, trying to open her clenched fists to place toys in them, to straighten his 'folded' arms and play with her. 9. At this point I summarise his evidence by identifying the following features: (1) Professor Nussey has a clear and far-reaching understanding of endocrinology and the systems involved with Vitamin D and bone mineralisation. I note his view that osteogenesis imperfecta was 'exceptionally unlikely.' An X-ray showed a spiral fracture of the left humerus. Amaka lectures regularly on various radiology, paediatric, genetic, emergency medicine and orthopaedic courses, locally and nationally. Over the next 10 months the Wards were visited by at least three expert witnesses who had been asked by the judge to give their opinions. Consultant Paediatric Radiologist and Service Group Lead for Radiology, Alder Hey Childrens Hospital, Liverpool, UK. However, in due course Dr Joanna Fairhurst, consultant paediatric radiologist, identified fractures to the left upper arm, right lower arm, distal left femur, left tibia, right tibia, and two rib fractures. It was the maternal grandmother's view that her daughter and son-in-law did not injure S. The maternal grandmother also mentioned that she had cared for her own children, relatives and grandchildren and was capable of ensuring that children are properly and safely cared for. The Consultant Paediatrician, in his report of 5 March 2012, picks up on the record that T would become annoyed when S was unable to play with him, not understanding that it was not possible. 09. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. Birmingham B4 6NH, Questionnaire for parents with children aged 5-9, Monday, Wednesday and Thursday/Friday afternoon, Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning. The Judge surveyed the 'wide canvas' of the case including the manner in which the parents gave their evidence. "It was a nightmare which seemed to be spiralling out of control.". He has been able to contribute vital knowledge and information towards understanding S's condition in August, September and October 2011. Metaphyseal fracture of the proximal left tibia caused when (a) her left leg had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury with discomfort lasting several days. I have taken account of the occasions when S was seen by medical staff. Torus fractures can result from a fall, from a direct blow, or from indirect forces applied to the limb when the leg is gripped and forcibly bent, a force well in excess of normal day to day handling of an infant. 45. On the balance of probability T could not have caused the injuries to S either by (a) jumping on the family bed whilst S was lying on it or (b) pulling her bouncy chair when she was in it. My close examination of this material has focused on the parents' accounts as well as on the evidence they have subsequently given about what they saw. I make this observation. S was discharged and the parents reported that her knee improved. With Doctuo you can find the doctors you need. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. The Judge was satisfied that neither the mother, father, nor grandmother could be held responsible for causing the injuries. She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. 2. It must also raise as a real possibility the potential explanation that T may have brought about one or more fractures, along with the possibility less likely, in my view that S may have been injured when the family slept together in one bed. 6. 03. ,8KaF"*w!$uOEF!1 Her research interests are in the imaging of suspected child abuse and skeletal dysplasias and in methods of determining which children have fragile bones prone to fracture and which do not. The father's responses set out a general defence to each allegation setting a number of relevant points that formed part of his evidence. John is a Consultant Endocrinologist at Queen Elizabeth Hospital Birmingham (QEHB) and an Honorary Senior Lecturer at the University of Birmingham. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. England, Population The family are very close and have a loving relationship. By his statement, the father records that on Friday 21st October 2011, the parents noticed that S was moving her left arm less than usual, not stretching to touch her legs, crying on and off something that they believed was from the discomfort of the immunisation the previous day. 10. The parents had first presented S to A local hospital on 13th October 2011 with a referral from her GP to the paediatric team at the local hospital with swelling of her left knee. The case against the Wards also relied on the view of Dr David Vickers, a community paediatrician, that if no obvious explanation could be found for an injury then child abuse was likely. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital S's early developmental history, after her birth on 18 July 2011, was unremarkable at first sight: more would come to be known about her Vitamin D deficiency later, with ensuing events. There is no radiological evidence that S suffers from rickets or any other vitamin deficiency. She was accompanied by both parents. While I have taken account of inconsistencies with the records available, I did not form the view that her evidence was demonstrably or readily to be interpreted as that of someone seeking to mislead the court, cover her tracks or draw a veil of ignorance over matters about which she had some knowledge. To access the survey, please click here. His claim that William had suffered four fractures on at least two occasions was contradicted by their assertion that he had only two fractures, both of which had probably been caused at the same time. She was described as remaining "settled in A&E, observations in normal range, apyrexial." The report states that S: 'cried a lot last few weeksMore over last 2 weeks and then doesn't want to be fedTends to cry more in the eveningHave used Infacol under advice from the H/V but no improvement yet. However, I note the high level of engagement with the medical services throughout T's life and the attention and care that he needed and received, caused by his own particular medical condition. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. I derive particular assistance from his evidence and the conclusion that S had a greater vulnerability to fracture, which he described as a reasonable conclusion, and at the times when they are likely to have occurred. A couple cleared of injuring their baby son have won a legal battle to identify the doctor who gave evidence against them. 20. There is no evidence of an incident of any kind suggestive or on which an inference could be drawn that either of the parents was responsible for an injury (other of course than the X-rays of the fractures). Right wrist fracture, a metaphyseal (bucket-handle) fracture of the distal right radius (difficult to date). the fractures to the right tibia and the proximal left tibia are likely to have occurred at the same time, and that that is the likely time-frame for them both.19. I come to the conclusion that Dr Fairhurst's evidence as to the identification of the injuries is, taken as a whole, and in the light of all the evidence and my acceptance of Dr Fairhurst's evidence in her own field of specialism, reliable and acceptable. I draw the conclusion that it is reasonable in S's case to assume that a lesser degree of force would be required if her bones were sub-optimal as a result of Vitamin D deficiency, which I am satisfied on the evidence that S's bones probably were, viz., Vitamin D deficient. (S> $}=I% l S2QBC(*YMhTX^Gf=,HO)t}cg3F 0s/yGUu. The concerns of the local authority and the allegations raised against the family members arise from the appearance on X-ray scans first seen on 22nd October 2011 of a significant fracture to S's left upper arm. %PDF-1.6 % The deal meant they could never be alone with their own son out of concern that they would cause him further harm. &/6kc`&EnFl! h~aka }mfh{p#P\fv}Clh+r9>XY7U&l5 tfL(h~)=O.szywUafH9!dN2-bs4XW+w2?b;NWNl 5ybc i20 V*a Qjff`# 2E,C\v{:]nJI'G,6]$kBEGs0XX'O-J(|- KTg}LzgNY (2) I note his evidence that there is no uniformity of Vitamin D testing in the United Kingdom and that Vitamin D is difficult to measure. The particular issue of Vitamin D deficiency/insufficiency presents as the current medical frontier and arguably an expanding and uncertain one. This produces a complex and difficult balance in assessing the likelihood of the infliction of the harm and the injuries as invited by the local authority. It is necessary to take account in combination with these reports of the dates provided by Dr Fairhurst for the occurrence of the various fractures to S, the clinicians' observations, also the X-ray and the report of nothing abnormal on 13 October 2011. There was an additional right wrist fracture which was difficult to date. He found it was not possible to conclude at what point normal day to day handling crossed over to the point when S's vulnerable bone structure was compromised and exceeded. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. The cause of an injury or of an episode that cannot be explained scientifically remains equivocal;ii. The maternal grandmother had no concerns in relation to the parents' care for both S and T and would like S to be returned to her parents' care.40. Earlier records that day mention mother and father being present. If there is some innate contradiction in that sentence it appears that the latter part of that sentence represents the stronger conclusion. Based primarily on the evidence of Dr Fairhurst, the local authority has levelled a broad spread of allegations against the three adults in the household at the material time the mother, father and grandmother. The first section lists common clinical presentations, the differential causes and the appropriate imaging pathways needed to confirm the diagnosis, with recent imaging advances for each condition. The fractures of the ribs require considerable force and well in excess of day to day handling or even rough play. Her case is that she came to the United Kingdom specifically to support her daughter and son-in-law with the day to day care of the children. The court had no expert views on these aspects or on a number of potential issues relating to bone metabolism. Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of a natural cause;iv. She states that they do not occur accidentally and this type of fracture is highly indicative of non-accidental causation requiring a force well in excess of that used in normal day to day handling of an infant. I have examined the process by which the fractures were discovered and that it was not until the report of Dr Fairhurst, consultant paediatric radiologist, of 13th February 2012 that the full extent of the injuries alleged to have been sustained by S were revealed and her report included three new areas of injury not seen or confirmed by earlier reports. s Pediatric Diagnostic Imaging textbook is renowned as one of the oldest and most prominent general textbooks in the field of paediatric text consists of two reasonably sized volumes covering all key areas using an intuitive systems-based approach. 37. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". It also records the following: "Mother is not able to recall how the fracture might have occurred: S, she advises, was using her arm less and appeared irritable from Thursday a.m. on 19/10/11 [sic 19/10 was a Wednesday] then went with Mum to have immunisations Thursday 1pm, where she was placed on a couch and not, to mother's recollection, held tightly, then seemed intermittently in discomfort with on-going reluctance to use her left arm as much as right, then today arm appeared swollen. In all sections, the value of all imaging modalities are stressed. The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." The local authority place considerable weight on the evidence of Dr Fairhurst as to the interpretation and significance of the X-rays, the report of 13th February 2012 and the evidence as to the mechanism of injury in relation to spiral fractures, metaphyseal fractures, fractures of the antero-lateral aspects of the ribs and a torus fracture raise very serious implications for the family members. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. Read full profile Dr Khushnood Alam Consultant Radiologist Biography pending. Formula feeding for 8-9 weeks before the test would have provided some improvement but not enough, as breastfeeding would provide none. courses@infomedltd.co.uk+44(0)20 4520 5081. Nearby doctors Sarah Yusuf Nazia Anwar Kaushal Finding of Fact Hearing in Respect of a Number of Fractures Sustained by S aged 3 months, On 13 October 2011 S was taken to hospital by her parents with a swelling to her left knee. I note the entry as follows: 'non-tender, baby permits passive manipulation. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. Reviews aren't verified, but Google checks for and removes fake content when it's identified, Oxford Specialist Handbooks in Paediatrics, Medical / Allied Health Services / Imaging Technologies. Having reviewed the evidence in detail, and after considering the written submissions of all parties, I had reached a position where I had come to my conclusions on the issues of fact. When to refer and why Dr Rajendranath Sinha, The Newcastle upon Tyne Hospitals NHS Foundation Trust Metaphyseal bucket-handle fracture of the distal right radius caused when (a) her right wrist had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury. After 22 September 2011, S was next seen at the GP surgery on the 13 October 2011. DAY 2: EMERGENCY PAEDIATRIC IMAGING - THURSDAY 10 FEBRUARY 2022 Arrested, charged by police and threatened with having their child taken away by Cambridgeshire county council's social workers, it took two years for the Wards to clear their name. She also asserted that in her view there was no correlation between Vitamin D deficiency and fractures nor was there an increased propensity to fracture due to a Vitamin D deficiency. I came to the conclusion that I was unable to determine the case without further specialist expert evidence. 36. Injuries to S could not have been caused by a person rolling onto her. Country The strong impression given is that the parents and maternal grandmother are careful, child-focused and conscientious parents who have demonstrated the quality of the attention they have given to dealing with T's special health needs and to S as they have arisen. 41 0 obj <>/Filter/FlateDecode/ID[<2E609F2171D9B848924D49576AA30896>]/Index[34 24]/Info 33 0 R/Length 56/Prev 68695/Root 35 0 R/Size 58/Type/XRef/W[1 2 1]>>stream Companies associated with this officer had at least 253,361 shareholder value in recent accounts. Her special interests include musculoskeletal radiology and trauma, particularly imaging in inflicted injury. We wanted to be able to name expert witnesses in order to help all those other families who are going through what we went through.". The 30 September 2011 is the earliest date for the left femoral fracture, but Dr Fairhurst took the view that the most likely time of occurrence was between 10 October and the visit to the GP on 13 October.She also thought that the two leg fractures, i.e. Infacol was helping When they stopped giving her that the crying worsened.Small vomits with it usually just food coming up with burpingStarted bottle feeding 1/12 [one month] ago.Yesterday, note that [baby] not happy straightening her left knee. Mr Johnson, who is chairman of the British Society of Paediatric Radiology and works as a consultant at Birmingham Children's Hospital, told police that in his view William had suffered repeated fractures and had a history of being abused. I therefore granted an adjournment so that a suitable expert could be instructed. 5. He therefore accepts that these fractures would have occurred while S was in their joint care. Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. As with the mother, that did not mean that there were no instances when they were confused or mistaken.48. Contents hosted on Doctuo should not be used as substitutes for professional medical advice, diagnosis or treatment. This, unfortunately, was soon to change. The injuries and range of dates are as follows. The local authority issued care proceedings on 2nd November 2011. She has contributed chapters to several well-respected radiology textbooks, and is co-author of two books, A Radiological Atlas of Child Abuse and Fetal and Perinatal Skeletal Dysplasias: An Atlas of Multimodality Imaging. 33. The scans were sent for further expert review by Dr Karl Johnson, paediatric radiologist at the Birmingham Children's Hospital. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. The book is an important revision aid as well as an up-to-date reference. I therefore come to the conclusion that the local authority has not discharged the burden of proof on the balance of probabilities. That theory has to overcome the difficulty that observations of S were made when she was seen at the clinic for weighing on the 19 October and for immunisations on 20 October, and the earliest reported symptom in the arm not moving her arm was on Thursday 20 October or Friday 21 October, which arguably places the timing of that fracture later than 19 October, as the Health Visitor and clinic staff could have been expected to notice or pick up symptoms and appearances that were (reportedly) evident to the parents on the Friday, and very apparent to the hospital doctors on Saturday 22 October 2011.29. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. Mindelsohn Way Birmingham B15 2TG 0121 472 1377 Birmingham Children's Hospital Steelhouse Lane Birmingham B4 6NH 0121 333 9999 Quick links Terms and conditions Give us your feedback Publications and reports Staff links AccessAble Freedom of Information Privacy Policy Accessibility statement Join us on social media Support us CT and x-ray are the first-line modalities, as these investigations are fast to conduct and have been shown to quickly reveal unexpected findings such as posterior rib fractures, metaphyseal corner fractures, and intracranial haemorrhage (especially subdural haematomas), contusions, and lacerations. Right lower leg fracture, a metaphyseal fracture of the proximal right tibia (shin bone) (12th September-10th October 2011). Her evidence was therefore protracted and interrupted and I note Miss Trustman's observation that her evidence lasted in Sri Lankan time from 4:05 pm to 8:20 pm, and I have no reason to doubt the accuracy of that record. Since the medical centre was closed, they took S to the local hospital.25. It soon became clear that both the police and social services were relying heavily on the evidence of Dr Johnson, who said that William had suffered four fractures which had taken place on at least two or more separate occasions. Thus the view of Dr Fairhurst, a considerably experienced and respected radiologist, is that all of the injuries would have required a force in excess of that used during normal day to day handling and that several of the fractures were highly specific for non-accidental causation of injuries. The consultant paediatric radiologist was able to date the fractures as follows: The rib fractures occurred between 15th and 28th September 2011. All prices include VAT, Viewers will be asked to evaluate each session and will be provided with a CPD certificate upon completion Erythematous [reddening on the skin]. If S were to be found responsible he offered the view that that would imply very poor supervision of T over a period of time. Fractures of the antero-lateral aspects of the left 8th and 9th ribs were caused by (a) a direct blow or compressive forces applied to her chest by an adult carer, (b) she would have shown distress for 10-15 minutes and shown discomfort when her chest was moved such as when she was dressed and a regular carer would know this was as a result of these fractures with discomfort lasting for a week. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. A number of strengths however have been identified during this short involvement. an understanding of the importance of applying the ALARA principle in Paediatric imaging. Dr. Karl John Johnson Radiologist Steelhouse Lane, B4 6Nh, Birmingham, England. 3. It is remarkable that these and in particular the hospital appointment of 13th October did not reveal or suggest the presence of fractures, nor did they raise any element of suspicion about the parents. No plausible explanation has been offered for any of these injuries. The impression given by this family and the parents and grandmother in particular is that they were a normal family dealing with their second baby, which by all accounts up to 13th October and indeed to 22nd October appeared to be unexceptional. You'll get immediate feedback and learning points from our expert faculty member. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Three days of this course provides 18 CPD credits in accordance with the CPD Scheme of the Royal College of Radiologists. 46. When the cause of his pain could not be found, they took him back twice more. This new, pocket handbook encompasses all aspects of paediatric radiology. endstream endobj 38 0 obj <>stream Rent and save from the world's largest eBookstore. A spiral fracture requires a force to cause a fracture in this way that is 'well beyond that used during normal day to day handling.' sub-optimal bones that have not yet developed radiological signs of rickets; (6) I note that she was not in a position to give an expert opinion on metabolic bone disease which she identified as a very complex subject beyond the radiological aspect and that she would defer to a metabolic expert; (7) she accepted that the lack of evidence for fractures occurring in patients with lower than normal levels of Vitamin D (who did not have radiological evidence of rickets) is the current state of research and acknowledged that there is a need for more study to be done; she further accepted that this is a developing and controversial area of medicine; (8) I noted that it is accepted by all medical experts that it is unknown what level of force would be required to cause the injuries in a baby that had a Vitamin D deficiency or insufficiency; understandably it is not possible for experiments to be carried out. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. S's father is represented by Miss Deschampneufs. The local authority made an application for an Emergency Protection Order on 26th October 2011 in respect of both children, and on 27th October the parents agreed to Section 20 accommodation. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . "There seems to be a small group of expert witnesses who often condemn parents. The mother and/or the father and/or the grandmother is the perpetrator of the injuries to S.19. Accidentally with the CPD Scheme of the Children has been there since 1998 October! S 's level was 30-35 when she was seeking to assist the court had no expert views these... Been identified during this short involvement WI March 27,, a Internist practicing in Madison, WI March,. The adults appear to be a small Group of expert witnesses who condemn! 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